William Foege Q&A: Public Health Law

Oct 11, 2012, 9:00 AM

William Foege

More than 500 public health legal experts, advocates, practitioners and researchers gathered in Atlanta, Georgia, this week to discuss the top issues facing the field. William Foege, MD, MPH, kicked off the conference with a keynote address at the 2012 Public Health Law Conference. Foege is a celebrated epidemiologist and physician who played a leading role in many of the important public health campaigns of the past half-century, including efforts to eradicate smallpox. Dr. Foege previously served as the director of the Centers for Disease Control and Prevention and formed the Task Force for Child Survival and Development.

In his keynote address, Dr. Foege said, “Every public health decision is based on a political decision. The basis for political decisions is law.” He also urged attendees to take action. “Burying our heads is no longer an option. There are solutions, but they require changing the laws that affects what happen to our health.”

We caught up with Dr. Foege to get his take on the critical role of public health law.

NewPublicHealth: As keynote speaker, what was important to you to convey to the hundreds of people in public health capacities attending the 2012 Public Health Law Conference?

Dr. William Foege: What I have emphasized is that the law is probably the second best tool we have ever had in public health after epidemiology. We’ve used it for a long time even if we did not have a formal organization, and when one looks at all of the spectrum of things accomplished from fluoridation to school entry requirements for immunization to what’s happened with air quality and water quality, you realize that this has been very important for public health.

NPH: What is one public health issue you’d point to that has been helped significantly by laws to carry it forward?

Dr. Foege: Now, that’s a tough question, but to pick one—what has happened with vaccines and immunization has just changed public health totally in this country and in the world. Think of all of the laws that are involved in the regulation of producing the vaccine, all of the research that went into developing the vaccine and the regulations and laws concerned with that, and regulations on field trials. Now we have school entry requirements for immunizations, which has done so much to make that an accepted practice.

NPH: You said, “The single biggest social determinant of health is poverty.” What legal approach did you discuss?

Dr. Foege: The single most important social determinant of health is poverty and we seem to accept that as that’s just the way it is. It shouldn’t be that way. I pointed out on the first day of the conference that everyone in that room benefited because they were subsidized by poor people working at minimum wage. They got their clothes and their food and their hotel room cheaper because of poor people. I tried to lay out some ideas on how law and policy in public health could change what happens to poverty levels in this country and around the world.

We shouldn’t be talking about a minimum wage. We should be talking about a living wage and actually make it a living wage, but then we should index it to the consumer price index or index it to something that you don’t have to return to every year. You solve that problem once and that’s it. But we also have to have a better feeling for what it is the poor are contributing to society. We certainly haven’t discussed what the poor contribute to the defense of this country; people that are well off are not volunteering for the military, and so we have a skewed distribution of poor people in the military, which means even the deaths are skewed and they’re paying a high price in death and disability in order to protect this country. We don’t seem to recognize that as a contribution of poor people.

NPH: Is there anything about the concept of law in public health that I didn’t ask you that you would like to be able to comment on?

Dr. Foege: I would like to say how it has grown over the years, which means people are understanding it to be of value or they wouldn’t be traveling out for a conference. People are beginning to understand how important it is.

This commentary originally appeared on the RWJF New Public Health blog.